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[Gui Yi Cao] A lesion arising at the center of the crown (Baihui area) is called Nao Yong (Brain Abscess), Nao Ju (Brain Carbuncle), or Nao Shuo, all occurring above the Dazhui point entering the hairline. Nao Yong has thin skin and ruptures easily; prompt rupture and pus drainage pose no danger. Nao Ju has thick skin and is difficult to rupture; internal toxins must be urgently dispersed via internal medication to allow rupture. Nao Shuo is a single lesion that initially feels like a transverse wooden beam dug into the ground, extending from the vertex to the Dazhui point. It swells with burning pain, appears dark blue-black like boot leather, is hard without visible pus, and the outer skin soon breaks away resembling dog-bite wounds; it is difficult to heal. The Ling Shu states: "Excessive expansion of Yang Qi consumes brain marrow and flows into the neck, named Nao Shuo." If the complexion does not change with treatment, accompanied by brain-neck pain as if pierced by needles and irritability, it is a fatal, untreatable condition.

[Xue Ji] The head belongs to the Foot-Taiyang Bladder Meridian, often caused by accumulated heat. Etiologies include surging damp-toxin, Yin deficiency with blazing fire, or depletion of Kidney Water and essence. Initially, there is severe red swelling and pain, irritability, thirst for cold drinks, and a flooding, rapid, and forceful pulse, indicating surging damp-heat; use Huanglian Xiaodu San (Coptis Decoction to Eliminate Toxins) combined with garlic-separated moxibustion to dispel damp-heat. If there is diffuse swelling with slight pain, thirst without preference for cold drinks, and a flooding, rapid but weak pulse, this indicates Yin deficiency with blazing fire; use Liuwei Wan (Six-Ingredient Pill with Rehmannia) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to nourish the source of transformation. If accompanied by dry mouth and tongue, frequent urination, or painful dribbling, this indicates Kidney Water depletion; urgently use Jiawei Bawei Wan (Modified Eight-Ingredient Pill) and the aforementioned decoction to secure the root and guide fire back to its source. If pus does not form and tissue does not putrefy, it is Yang Qi deficiency; if granulation tissue does not grow and the wound does not close, it is Spleen Qi deficiency; use Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction). If the color is dark and non-ulcerating, or ulcerating but non-healing, this is essence depletion, named Nao Shuo, which is incurable. However, with appropriate tonification and purgation, recovery is possible. Practitioners must exercise caution.

Yuan Haowen recorded: I drank alcohol regularly. In the ninth month, a small sore appeared below the brain and above the neck. Days later, my brain and neck became numb, and the swelling spread outward. The surgeon prescribed Wuxiang Liaoqiao Tang (Five-Aroma Forsythia Decoction). By the eighth day, no pus had emerged, yet he claimed it could not be cured quickly. On the eighteenth day, pus finally emerged. With medication or bloodletting, it would take three months to flatten and four months to return to normal. I recall medical classics stating: "For any sore, if pus does not appear, nine out of ten die." True enough, I faced the regret of waiting helplessly for death. I then invited Li Dongguan (Li Mingzhi) to diagnose him. He said: "Diseases arising from rich foods and alcohol should not be treated with aromatic herbs. It is too late now; we must first employ fire therapy, followed by medication." Using large moxa cones the size of peach pits, he applied one hundred moxibustion sessions until pain was felt. Then he prescribed: "The disease is in the Foot-Taiyang Bladder Meridian, with rebellious Qi, requiring reverse treatment. The pulse is wiry and tight, flooding, rapid, and forceful upon pressure. We must subdue the dominant pathogen and address its cause. Though starting similarly, the outcome differs; we can break accumulations, soften hardness, harmonize Qi, and ensure cure. We must respect seasonal Qi and not damage Heavenly Harmony. From a seasonal perspective, sweating is contraindicated, and purgation is forbidden for both meridian and disease patterns. For knotting, we scatter; for hardness, we soften with salty flavors. However, since cold pathogens are involved, salty flavors are restricted. Therefore, bitter-cold herbs are used as Sovereign and Minister to clear heat, sweet-cold herbs as Assistant, and hot wine as Enabler due to the etiology. Pungent-warm herbs harmonize Qi and Blood; highly pungent herbs resolve knots as Ministers. Three pungent and three sweet herbs benefit Yuan Qi and harmonize blood vessels; acrid and bland herbs guide dampness from alcohol; supporting Autumn Qi to benefit Qi and drain fire; using meridian-specific herbs to harmonize blood as Guides. The primary action is unblocking the meridian. Sovereigns: Huangqin, Huanglian, Huangbai, Sheng Dihuang, Zhimu (wine-processed). Ministers: Qianghuo, Duhuo, Gaoben, Fangfeng, Fangji, Danggui, Liaoqiao (to resolve knots). Astragalus, Ren Shen, and Gancao are combined with bitter-cold herbs in a ratio of one-third; excessive amounts would nourish Ying Qi and tonify Earth. Raw Gancao drains Kidney Fire and benefits Lower Jiao Yuan Qi. Ren Shen and Chenpi tonify Stomach. Sumu and Danggui Wei remove bad blood. Sheng Dihuang nourishes Blood. Wine-processed Fangji removes residual heat in the Bladder. Zexie assists Autumn Qi to eliminate damp-heat from alcohol. All these herbs require Jiegeng as a boat and oar to prevent sinking. After administration, the carbuncle will cease pain and splitting, appetite will improve, and strength will return." I followed the prescription, slept deeply until sunrise, and found the swelling reduced by seven or eight tenths. Scabs formed and healed completely in fourteen days. While many surgeons achieve results, only Li Mingzhi could articulate the hidden secrets of the body. (Formula name: Huanglian Xiaodu Yin, see this section.)

One patient, who neglected diet and lifestyle, presented with red, swollen, painful lesions and a flooding, rapid Chi pulse. One dose of Huanglian Xiaodu San eliminated damp-heat instantly, leaving only hard swelling and pain. Two doses of Xianfang Huoming Yin (Immortal Life Elixir) resolved swelling and pain, but the sore head persisted. Tenxuan San (Ten-Auspicious Powder) without Rougui, plus Jinyinhua, Gaoben, Baizhu, Fuling, and Chenpi, were used to support the interior and drain pus. Desiring complete resolution, he self-administered two doses of his own Huanglian Jiedu San, resulting in increased hardness and failure to suppurate. He then realized his error. Tenxuan San with Baizhu, Fuling, Chenpi, and Banxia reduced swelling slightly. Removing Rougui again and adding four more doses led to suppuration and reduced swelling. Subsequently, Bazhen Tang (Eight-Treasure Decoction) with Huangqi, Wuweizi, and Maimendong was used, leading to suppuration and healing after over a month. Bitter-cold herbs, even for Yin syndromes, must distinguish exterior/interior and deficiency/excess, following sequence and timing; they cannot be used indiscriminately from start to finish. Red swelling and pain with a rapid Chi pulse, soft upon pressure, indicate abundant damp-heat in the Bladder Meridian; thus, Huanglian Xiaodu San detoxifies and drains dampness. Hard swelling and pain result from stagnation of Qi and Blood; thus, Xianfang Huoming Yin disperses knots, detoxifies, and invigorates blood. The persistent sore head is due to heat-toxin steaming and Qi/Blood stagnation; sweet-warm formulas should tonify Yang Qi and support the interior to promote putrefaction and drainage. This condition originally belongs to the Du Mai (Governing Vessel), arising from deficient fire. Without addressing the cause and using only bitter-cold herbs, Stomach Qi is damaged, hindering putrefaction and healing, leading to collapse. Sores that dissipate, suppurate, and heal easily do so because Qi and Blood are robust.

Another patient with Nao Ju for over ten days had swollen eyes and face, head enlarged like a bucket, flooding rapid pulse, irritability, and thirst for cold drinks, caused by Bladder damp-heat. Two doses of Huanglian Xiaodu Yin reduced symptoms. Drinking two bowls of Huaihua Jiu (Sophora Flower Wine) caused immediate reduction. Pressing the swelling caused it to rebound, indicating pus formation. Holes were punctured in the neck, forehead, shoulder, and cheek, releasing pus, opening the mouth and eyes. Interior-supporting herbs plus Jinyinhua and Liaoqiao for over thirty doses led to recovery.

Another patient with severe Nao Ju and a solid pulse did not respond to Huanglian Xiaodu San. Two taels of Jin Yin Teng (Honeysuckle Stem) were decocted in two cups of water to one cup, mixed with half a bowl of wine. Symptoms decreased by three or four parts after one dose, gradually subsiding with repeated doses. Huangbai, Zhimu, Gualou, Danggui, and Gancao Jie were added, leading to suppuration cessation after several doses. Huangqi, Chuanxiong, Baizhu, and Jiegeng were added, leading to recovery.

A woman nearing seventy, robust in constitution, impatient, and fond of alcohol, developed Nao Ju. Five days in, her pulse was urgent and choppy. Da Huang (Rhubarb) was wine-steamed, sliced finely, stir-fried with wine, powdered, then stir-fried with Ren Shen and wine. Ginger was added for decoction. One qian was taken, repeated after two hours. She slept, sweated on the upper body, and woke with the illness gone. This illustrates the principle of interior support. (Note: Treatment addressed impatience, alcohol habit, and pulse. Urgent/choppy pulse indicated blood injury from impatience/alcohol; Da Huang drained alcohol-heat, Ren Shen nourished Qi and Blood.)

Du Qingbi suffered from Nao Ju unresponsive to treatment. Danxi visited and asked why he didn't take Fangfeng Tongsheng San? He replied he had taken several doses. Danxi advised processing them with wine. Qingbi realized his mistake.

A woman had left-sided brain swelling and pain, purulent discharge from the left nostril for over a year, occasional dizziness and vertigo as if on a boat. Xu Shuwei stated: "Liver deficiency allows Wind Pathogens to invade." Prescription: Chuanxiong (1 liang), Danggui (3 qian), Qianghuo, Xuanfuhua, Xixin, Fangfeng, Manjingzi, Shigao, Gaoben, Jingjie Sui, Banxia Qu, Sheng Dihuang, Gancao (each 0.5 liang). Take 1 liang per dose. One course cured her. (Note: Diagnosed as Liver deficiency with Wind invasion. Treated with wind-dispelling, heat-clearing, blood-nourishing, phlegm-resolving herbs due to vertigo and left-sided pain. Classics state: All wind-induced tremors/vertigo belong to Liver Wood. Left-sided pathology relates to Liver/Gallbladder. Wind enters from above. No phlegm, no vertigo. Liver stores Blood. Wind is a Yang pathogen. Thus, treating wind, heat, phlegm, and blood is logical.)

An elderly patient with red, swollen, painful lesions and a rapid, forceful pulse improved slightly with two doses of Huanglian Xiaodu Yin, then cleared with four doses of Qingxin Lianzi Yin.

A woman contracted this in winter with swelling, pain, heat, and thirst. Heat-clearing and detoxifying herbs led to suppuration and healing. In March the following year, her tongue swelled, and she developed numerous carbuncles like grapes all over her body, especially hands and feet, indicating Stomach/Spleen toxicity. Black blood was pricked out, followed by seven pills of Mingdan (Life-Rescuing Pill), causing foul-smelling sweat and increased sore heat. Constipation for two days was treated with Da Huang, Huangqin, Huanglian (each 3 qian), Shengma, Baizhu, Shanzhi, Bohe, Liaoqiao (each 2 qian), and raw Gancao (1 qian). Decoction boiled briefly. Large amounts of foul blood were excreted, reducing lower body symptoms. Rhinoceros Horn juice was added and administered again, releasing foul blood from the tongue base and gum lines, eliminating toxins. Finally, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) completed the cure.

The above cases involve Foot-Taiyang Meridian accumulated heat complicated by Wind, Dampness, or Deficiency. Their progression and regression demonstrate the flexible application of Huanglian Xiaodu San.

Huanglian Xiaodu Yin
Huanglian (5 fen), Huangqin (5 fen), Huangbai (wine-washed, 5 fen), Ren Shen (5 fen), Zhimu (4 fen, wine-fried, used as Sovereign to guide bitter-cold herbs through meridians), Qianghuo (1 qian), Duhuo (5 fen), Fangfeng (5 fen), Gaoben (5 fen), Liaoqiao (1 qian, used as Minister to resolve meridian knots with pungent flavor), Huangqi (1 qian), Gancao (roasted, 5 fen, combined with bitter-cold herbs in one-third proportion; excess nourishes Ying Qi and tonifies Earth), Danggui Shen (1 qian, wine-washed), Sheng Dihuang (1 qian, wine-washed, used to harmonize and nourish blood with warm-pungent flavor), Chenpi (5 fen, peel retained to tonify Stomach Qi), Gancao Shao (5 fen, raw, used to drain Kidney Fire and benefit Lower Jiao Yuan Qi with sweet-cold flavor), Zexie (7 fen, acrid-bland to guide alcohol-dampness, support Autumn Qi), Fangji (5 fen, wine-washed, remove residual Bladder heat), Danggui Shao (5 fen), Sumu (5 fen, remove bad blood), Jiegeng (1 qian, prevents herbs from sinking, acts as boat/oar). Herbs washed in wine or decocted with wine use wine-heat as an enabler.
All ingredients constitute one dose. Decoct three cups of water until half remains, strain, add a little wine, re-decoct, and take warm after meals. Do not drink water after administration, or pus will reform and efficacy will be delayed. For early-stage onset (3 days), immediate effect is expected. All sores are either Yang within Yin or Yin within Yang.
Dong Yuan treated carbuncles with 70% Yang-tonifying and 30% Yin-nourishing herbs, named Shengyang Yiwu San (Raise Yang and Benefit Stomach Powder), suitable for the elderly, also called Fujian San. May be supplemented with Moyao and Ruxiang (1 qian each).
Dong Yuan's discussion on diseases from rich foods/meat advocates bitter-cold over aromatic herbs, such as Neixiao Shengma Tang (Internal-Dissolving Corydalis Decoction) and Sun Simiao's Da Huang Tang (Rhubarb Decoction), designed for the wealthy meat-eaters.

Qianghuo Danggui Tang treats Nao Ju.
Huangqin, Huanglian (both wine-fried), Danggui Shen (wine-soaked), Zhi Gancao (each 1 liang), Qianghuo, Huangbai (wine-soaked), Liaoqiao (each 5 qian), Zexie, Duhuo, Gaoben (each 3 qian), Fangfeng, Zhizi Ren (each 5 fen).
Crush into coarse powder. Divide into four doses. Soak in one small bowl of water for about an hour, add one spoon of wine, decoct to 80%, strain. Take very warm after meals, twice daily. Include dregs for six doses total, finished in three days. Strain; take the clear liquid with Binglang San (Areca Nut Powder).

Binglang San
Binglang (Areca Seed) powdered. Mix with Qianghuo Danggui Tang.

Chen Lu Pan's mother, over seventy, developed a carbuncle on the head after Winter Solstice, size of a bowl. Surgeons waited for ripeness to lance. Due to beating a servant, the sore sank inward slightly. Complexion was dull yellow-green, limbs cold, sweating with clear fluid, occasional vomiting, pulse extremely deep, fine, and slow. Due to old age, severe cold, suffering, bland diet washing away rich Qi, leaving emaciation, plus sudden anger damaging Spirit, this cold transformation occurred, matching the season/time. Discussed with surgeons, immediately prepared Wuxiang Tang (Five-Aroma Decoction) with Dingxiang and Fuzi (each 5 qian). After finishing the dose, the carbuncle flared up significantly, and subsequent symptom-based treatment led to recovery. Nei Jing states: "In treating disease, always observe the lower [symptoms/context]." Meaning observe seasonal appropriateness. "All pain, itching, sores, and ulcers belong to Heart Fire" refers to the norm. But when sores are severe while the body is emaciated, pathogen is high but pain is low, starting hot ending cold, this is abnormal; one must adjust treatment based on seasonal appropriateness. Thus: Classics are norms, methods are applications, medicine is intuition. Treating according to appropriateness yields perfect results. (Note: Elderly in winter cold suggests warming/tonifying. Why use pungent-dispersing Wuxiang Tang with Ding/Fu? Anger caused Qi stagnation blocking Yang circulation, leading to sunken carbuncle and deep/slow pulse. Thus, Wuxiang opens knots, Ding/Fu assist Yang. Stagnation disperses, Yang recovers, carbuncle flares. Treatment matched constitution and pulse.)

Jinyi Ye Fu Ren suffered from Nao Ju with dry mouth/tongue. Internal heat-clearing and external cooling applications resulted in dark, non-ulcerating lesions and chest oppression, indicating Yang deficiency/cold. Suspecting chronic Phlegm-Fire and rejecting warming/tonics, Xue prescribed Renshen and Huangqi (each 5 qian), Jiang and Guizhi (each 2 qian). One dose caused immediate swelling and suppuration. Major tonics completed the cure.

One patient, near suppuration, had mild pain and thirst, with a large but weak Chi pulse, indicating Yin deficiency with moving fire. Believing it was Heart Fire-Toxin, he self-medicated with cooling/fire-draining herbs, worsening symptoms. Seeking treatment, he received Siwu Tang with Huangbai, Zhimu, Wuweizi, Maimendong, and Huangqi, plus Jiawei Bawei Wan. Thirst stopped, sore ulcerated. Interior-supporting herbs and the pill completed the cure.

A woman over eighty had an ulcerated Nao Ju, followed by Fa Bei (Back Carbuncle) with millet-sized heads, large but weak pulse, caused by Bladder Meridian damp-heat. Weak pulse indicates Qi/Blood decline. Several doses of interior-supporting detoxifying herbs helped slightly. Adding Renshen and Huangqi helped, but thirst remained due to severe Qi/Blood deficiency. Renshen/Huangqi (each 1 liang), Danggui/Shao Yao (each 5 qian), Maimendong/Wuweizi (each 1 qian) stopped thirst after several doses. For non-suppuration, Rougui was added for over ten doses. Once pus formed, it was lanced. Necrotic tissue gradually rotted and was removed slowly. Clear pus failed to heal; Shiquan Dabu Tang with Bailian, Beimu, and Yuanzhi for over thirty doses thickened pus and cured it. Without vigorous tonification and debridement, mistaking thirst for fire and using cooling drugs would surely lead to death. Although sores/carbuncles belong to Heart Fire, one must distinguish exterior/interior and deficiency/excess. If Yuan Qi is solid and internal excess fire exists, cold drugs may work. Overuse of cold damages Stomach/Spleen, transforming Yang syndromes into Yin, causing non-ulceration or non-healing, Yin-Yang disharmony, and imminent death.

One patient with Nao Ju and thirst had a flooding pulse, weak on pressure. Prescribed crushed Jiawei Bawei Wan. He disbelieved, used self-prescribed Yin-nourishing drugs, developed Seven Adversities, and died. Jing Yao states: "Although carbuncles involve heat, they arise from deficiency. Post-recovery thirst, or thirst preceding carbuncle, can only be treated with Jiawei Bawei Wan."

One patient with brain carbuncle had fever, thirst, increased pus, worse fever, red face/lips/tongue, painful urination, insomnia day and night, facing imminent death. Xue treated with Jiawei Bawei Wan formula plus Renshen, Huangqi, Danggui, Baizhu, Maimendong, and Gancao. Deep sleep for half a day resolved all symptoms. Few doses cured the sore. Xue said: "Though cured, consolidate the root." He neglected advice and dietary restrictions, suffered stroke the next year, and died from back carbuncle later.

An elderly patient with clear pus and thirst had a soft, choppy pulse. Diagnosed as dual Qi/Blood deficiency. Prescribed Bazhen Tang with Huangqi and Wuweizi. He disbelieved, took fire-draining herbs, vomited, and lost appetite. Believing thereafter, he took Xiangsha Liujunzi Tang for four doses, stopping vomiting and improving appetite, then resumed previous decoction, curing after a month.

One patient, pre-suppuration with thirst, had a large, weak Chi pulse. Siwu Tang with Huangbai, Zhimu, Huangqi, and Maimendong reduced thirst in four doses. Jiawei Bawei Wan stopped thirst and induced suppuration. Interior-supporting herbs and the pill completed the cure.

One patient with head/neck pain, severe swelling/pain despite large ulceration, diarrhea, irritability, insomnia, and poor appetite, showed dangerous signs. Pulse indicated lingering toxin. Xianfang Huoming Yin for two doses reduced swelling/pain by half. Ershen Wan and Liujunzi Tang plus Wuweizi, Maimendong, Suanzaoren for four doses improved symptoms, appetite, and sleep. Canling Baizhu San improved appetite further. Shiquan Dabu Tang plus Jinyinhua, Baizhu, Jiegeng cured after a month.

[Gui Yi Cao] Red carbuncles appearing on the forehead, front of the brain, and palms are fatal if not ulcerated within ten days. They can be lanced on the seventh day to release red blood. If no pus forms by the seventh day, it is untreatable. (Non-ulcerating means attacking east and west without forming a proper outlet.) Zhu Ju (Spindle Carbuncle) appearing on temples, beard, and ears is fatal if not ulcerated within fifteen days. Pus can be lanced; if black like fermented soybeans or bloody, it is fatal.